缺血性脊髓血管病60例临床分析

目的深入探讨缺血性脊髓血管病的病因、临床表现、影像学改变、诊断及治疗。方法对1993年2月~2003年10月我院收治的60例缺血性脊髓血管病患者的临床资料进行回顾性分析。结果该病41岁~70岁为高发年龄段,病因及危险因素主要为高血压病。最常见的首发症状为根痛,占63.33%。典型的体征为四肢瘫或截瘫,分离性感觉障碍,直肠、膀胱括约肌功能障碍。MRI在24h后显影较好,典型表现为脊髓增粗并伴有髓内长T1长T2异常信号。本组痊愈6例,好转45例(肌力增加II级以上),无改善8例,死亡1例。结论有心血管系统高危因素的老年人突然出现根痛、四肢瘫或截瘫、分离性感觉障碍、膀胱直肠括约肌功能障碍等症状应高度怀疑缺血性脊髓血管病,MRI在24h后显影较好,一般采用内科保守治疗。

Clinical analysis of 60 patients with ischemic spinal vascular diseases

Objective To explore the etiology, clinical manifestations,the changes of MRI,diagnosis as well as the optimum treatment program and enhance the recognition to ischemic spinal vascular diseases.Method We performed retrospective analysis of the original data of the 60 patients suffered from ischemic spinal vascular diseases during the period of 1993~2003.Results Most patients were 41~70 years old. The main etiology and risking factors was hypertension.The most common first symptom was radicular pain.The typical clinical manifestations were abrupt onset of weakness and,below the level of the lesion,flaccid tetraplegia or paraplegia,areflexia,loss of spinothalamic perception of pain and temperature,and autonomic deficits comprising sphincter flaccidity,atonic urinary baldder and paralytic ileus.MRI was sensitive after 24 hours from ictus.The classical image was hyperintensity on T_2WI,accompanied with hypointensity on T_1WI and cord swelling.In 60 patients, only 6 recovered and 1 died.Conclusion If old people with cardiovascular diseases have above typical clinical findings,we should think of ischemic spinal vascular diseases.MRI is sensitive 24h later.Generally,the patients were treated by internal method.